Case discussion: How would you treat this patient? [30 April]

This week we have an interesting case from Dr Alvin Prakash. An 23-year-old male with a history of changing lesion on his face.

Please review and describe the clinical and dermoscopic image. What is your evaluation, and proposed next step/s?

Case discussion    Case discussion

Case submitted by Dr Alvin Prakash


These are the results from the pathology report. What is your conclusion and what are the next steps you would take to treat this patient?

case discussion

We encourage you to participate in the case discussions and submit your own clinical images and questions, so we can all learn together.


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6 comments on “Case discussion: How would you treat this patient? [30 April]

  1. regression with a preexistent nevus, dermoscopic grey, pink area with vessels , need excision biopsy as its non characterisable as either seb K or CMN

  2. Interesting lesion, looks like 2 lesions colliding, one being a melanocytic one with blue-grey area in the middle but no pigment network and appears to be symmetrical and the other one possibly a bcc therefore I would be excising this lesion for diagnosis.

  3. Pink and brown. The pink shows polymorphic vessels. The brown bit shows white lines at the middle however no specific patterns. It could be SK but I would cut it out to rule out any malignancy.

  4. Chaos with bluewhite, asymmetrical, will need excisional biopsy w 2mm margin. its right in the tiger country so I may have to refer that, hope the patient can afford as public wouldnt take him w/o histo!

  5. I think this is a fascinating case. A young man, and a solitary pigmented skin lesion, changing. The fact that this is solitary makes it highly suspicious. Most unlikely to be SK and is almost certainly a melanoma. Needs a prompt biopsy. As Thuy says, it is tiger country, and so one option for biopsy is to infiltrate lots of local anaesthetic, to raise the lesion up, and then do a fairly deep shave biopsy. This will get a diagnosis and allow referral. This is an aggressive melanoma that needs prompt action.

  6. symmetrical upper pigmented lesion with central structureless whitish blue area and peripheral lower vascular lesions with different vascular pattern.
    This is suggestive of malignant melanoma arising in naevus with amaelanocytic area.
    differential diagnosis would be a BCC arising in a naevus
    in either case, it needs excision with 2 mm margin with possible further excision on obtaining its histology.